The View From Your Obamacare

This thread began when Andrew shared his experience with Obamacare thus far (included below), then continued when we asked readers to share their experiences as well (click here to skip to that section).

There are plenty of imponderables left on the fate of the ACA, Obama’s signature domestic policy achievement. Premiums could still spike later this year; the full data on the numbers with actual, paid-for health insurance via the exchanges is not yet known; the resistance on the right to it is still mighty; in many states, the lack of Medicaid expansion guts a key part of the law’s intent. If you want to read an attempt to argue that Obamacare is as big a liability for Obama this fall as the Iraq War was for Bush in 2006, well go read JPod. My reaction after reading his screed was: seriously?

There’s simply no denying that the law has been rescued by an impressive post-fiasco operation that did to ACA-opponents what the Obama campaign did to the Clintons in 2008 and to Romney in 2012. Obama out-muscled the nay-sayers on the ground. I have a feeling that this has yet to fully sink in with the public, and when it does, the politics of this might change. (Since the law was pummeled at the get-go as something beyond the skills of the federal government to implement, its subsequent successful implementation would seem to me to do a lot to reverse the damage.) There are some signs that this is happening. A new Reuters/Ipsos poll finds the following:

Nearly one-third of respondents in the online survey released on Tuesday said they prefer Democrats’ plan, policy or approach to healthcare, compared to just 18 percent for Republicans. This marks both an uptick in support for Democrats and a slide for Republicans since a similar poll in February.

That’s mainly because of renewed confidence and support from previously demoralized Democrats. But it’s also a reflection, it seems to me, of the political vulnerability of Republicans who have failed to present a viable alternative to the law, and indeed seem set, in the eyes of most voters, merely to repeal ACA provisions that are individually popular. And this bad position is very likely to endure because of the intensity of the loathing for Obama/Obamacare among the Medicare recipients in the GOP base. It seems to me that right now, the GOP cannot offer an alternative that keeps the more popular parts of Obamacare without the air fast leaking out of their mid-term election balloon. And so by the fall, the political dynamics of this may shift some more in Obama’s direction. By 2016, that could be even more dramatic. One party – the GOP – will be offering unnerving change back to the status quo ante, and the other will be proposing incremental reform of the ACA. The only thing more likely to propel Hillary Clinton’s candidacy would be a Republican House and Senate next January.

It’s that long game thing again, isn’t it? Like the civil rights revolution of the Obama years, it seemed a close-to-impossible effort to start with, and then was gradually, skillfully ground out. It also seems true to me that the non-event of the ACA for many, many people will likely undermine some of the hysteria on the right. The ACA-opponents may be in danger of seeming to cry wolf over something that isn’t that big a deal. Yes, they may have premium hikes to tout as evidence of the alleged disaster. And every single piece of bad news on the healthcare front will be attributed to the ACA, fairly or not. But the public will still want to know how premiums can go down without people with pre-existing conditions being kicked out of the system, or without kids being kicked off their parents’ plan, and so on. I think, in other words, that the GOP’s position made a lot of short-term political sense in 2010 and even 2012. But it’s a much tougher sell in 2014, let alone 2016. Once again, they have substituted tactics for strategy. Every time they have done that with Obama, they have failed.

I stayed on my Newsweek plan via COBRA for my first year as a new business-owner. But when I went on the exchanges this year before my COBRA ran out, I was pleasantly surprised. My old plan had a premium for me and my hubby of $1,535.59 per month, with an in-network out-of-pocket maximum of $2,500 per person. So in 2013 I had total out-of-pocket costs (premiums plus my out-of-pocket maximum of $2,500) of $20,927.08. This year, my ACA plan – a Platinum DC-based one – has a monthly premium of $1,106.33 for the two of us, with an in-network out-of-pocket maximum of $1,800 per person. My out of pocket medical costs this year will therefore be $15,075.96. (One small note: my previous plan was slated for a reduction in premiums this year as well. Not by as much as my current plan – but a significant one nonetheless. But since my COBRA option ran out this June, it wasn’t really a choice.)

So I’m a lot better off with Obamacare this year. I’m also buoyed by the fact that DC’s exchanges have a high number of the young and healthy in them – balancing out my aging AIDSy ass. So I’m reasonably confident my plan won’t go down the toilet any time soon, or face big hikes in premiums. And this new insurance means a lot more to me than the old one – because it cannot be taken away, even if the Dish goes belly-up. When you are a long-term HIV survivor, that kind of health security and independence is, well, priceless. Obamacare affected me in another critical way as well. Its assurance of a stable insurance market that does not screen out someone with a pre-existing condition made me far more comfortable starting my own business. It gave me a baseline of security that simply didn’t exist before. It helped make entrepreneurialism possible.

Yes, I am just one tiny, and rare example. But for me, at least, Obamacare has over-delivered and over-performed. If my experience is replicated more widely, then I suspect the polling and politics will shift yet again.
Meep motherfucking meep.

Being left out of the official statistics are people like me who purchased new policies directly from insurance carriers. Pre-ACA, they would not have insured me for any amount of money due to a long list of pre-existing conditions. As of January 1, they can no longer ask me those questions. I do not qualify for any subsidies, so there was no need for me to purchase insurance through the exchange. Instead, I bought insurance without the government middleman, courtesy of the ACA.

Another:

I’m a 29-year-old woman and a self-employed writer. Before the ACA passed, I was rejected by every health insurer in California because I had an abnormal pap smear and was diagnosed with HPV, which can cause cervical cancer. I was shocked – not by the diagnosis, which is very common, but by the fact that I could not get any coverage (I am otherwise very fit and in perfect health). I am eternally grateful for Obamacare – not because of the cost (which at $181/mo for a $2000 deductible is much cheaper than the Freelancer’s Union insurance in had in NYC of $270/mo for a $10,000 deductible), but because it allows me to get health care at all.

What troubles me about the health politics of the Republican party is that they seek to dismantle both Obamacare and Planned Parenthood, thus rendering a woman in my position without any sort of affordable preventative care. And there are a lot of women in my position. HPV is not a rare disease. According to the CDC’s website:

About 79 million Americans are currently infected with HPV. About 14 million people become newly infected each year. HPV is so common that most sexually-active men and women will get at least one type of HPV at some point in their lives.

But many women, myself included, do not like to talk about these details in public. I paid attention to the way people reacted to Sandra Fluke, and I am not interested in engaging in a public conversation about my sexual choices (though if you must know, I’m heterosexual, monogamous, and am engaged to a man I have been dating for five years). This, I think, is one of the reasons we don’t hear an outpouring of good publicity for Obamacare: the people who benefit most from it (self-employed, with a pre-existing condition) are less inclined to talk about their success stories because the subject matter is often too sensitive for a public forum, or for a name to be attached to it.

Another shifts focus:

The law has been helping my family in one key way since just a few months after its passage in 2010: my 19-year-old-sister gets to stay on my mom’s plan. My dad died in late 2012. If Obamacare hadn’t given us this option, keeping my sister insured would be an all-hands-on-deck financial effort by myself, my mom and probably my little brother. It would be a huge drain on the incomes of my entire immediate family.

Now? She’s had coverage consistently since exceeding the age of 18 and apparently can continue to have coverage for another six years. In the meantime, she’s getting a degree and starting her first part-time jobs, so she’s probably on track to be pay for her own insurance by the time she is 26. In a world without ACA, she couldn’t have this college experience. She’d have to go to school part-time and work more. Obama is helping my family help my sister have the kind of college experience she deserves and I am tearing up just typing this to you.

Update from a reader:

As you know, I’m an advocate of Obamacare. However, I have to point out that your third reader is apparently either mistaken or doesn’t know about one huge change in the marketplace due to the ACA. Now this may differ from state to state, but here in CA, prior to 2010, children could stay on their parents ONLY IF they are full-time students. Only if she was a part-time student would she have had to carry her own insurance.

There is one huge change to the law that affects parents. Prior to 2014, here in CA, one child’s premiums paid for all children. So if you were Kate whatshername and had 8 children, you’d still only pay for one. I think this is what your reader meant by not having a “huge drain on the incomes on my entire immediate family.”

Starting in 2014, with all new ACA plans, a parent has to pay for up to three children’s premiums, as long as they are under 18. Any child over 18 will have their own premium. So, if a parent had six children, three under 18 and three over 18, that parent will have to pay six premiums along with the parents. If the scenario was five children under 18 and one over, that parent would have to pay for four children’s premiums.

So that third reader? She may be in for a huge surprise when the mom renews. It sounds like the mom had to pay for two premiums before, and now will be looking at three, four if the writer is under 26.

You know what surprises me? I haven’t read one story in the media about this change. And I think it’s because parents have known all along, that the old way was a very nice free ride.

Another provides some supplemental info on the subject:

This link has state-by-state laws on eligibility. Looks like 19 is the youngest a kid would no longer qualify for parents insurance. But there were lots of exceptions to that age depending on the state. Often a kid could remain on insurance longer if they were a student. Here is a key part of an issue brief (pdf) on the subject from 2010: “Young adults covered as dependents on their parents’ employer policies often lose eligibility for that coverage at age 19 or upon graduation from high school, particularly if they do not go on to college.” And here’s part of a useful Kaiser brief (pdf) from 2010:

Approximately 25 states have extended the age that young adults can remain on their parent’s health insurance plan, but policies regarding who is eligible for this coverage vary widely. Most of the states that have these policies in place extend coverage to young adults up to age 25, but some states extend dependent coverage to age 24 or 26 and New Jersey extends the dependent age to 30. Some states mandate that eligible young adults be unmarried, be students, or be living in the same state as their parent with private coverage. State requirements to extend coverage to dependents do not apply to insurance plans that are self-funded. The federal requirements in the health reform law are designed to apply to these self-funded plans, along with other private insurance plans.

The new federal health reform law will be applied to all states, including those who have already expanded dependent coverage to some young adults. Young adults in states with narrower eligibility criteria than the federal law will now be able to take advantage of the federal law. States that have broader eligibility for dependent coverage will be able to continue their current state policies, which will enable more young adults to qualify for dependent coverage in those states than would qualify under the federal law.

Thank you so much for giving me a platform to share my Obamacare success story! Well, actually, it’s my brother’s story and it starts about a year ago. He was 25 and working for a small radio group in Ithaca, NY. He got into a PhD program at IUP, and since he was barely making any money, he decided to quit his job and spend the summer relaxing and traveling and visiting friends before starting school.

Those plans got thwarted when he was diagnosed with thyroid cancer in June. Three surgeries later, I am happy to say that he is in recovery and doing great, but damn, my family would’ve been fucked without Obamacare. It let my brother stay on my parents’ insurance, so he was covered when he got his diagnosis. I’m not sure what the costs of his treatment have been exactly, but the bill for just administering the radioactive iodine pill he had to take was almost $200,000. When you add to that all the tests and the three surgeries, the costs have got to be close to a million, if not more. My family would likely be considered well-off, but those costs would’ve bankrupted us.

It’s possible that he would’ve been on Cobra without Obamacare, but I think it’s at least equally likely that he would’ve decided to just wait until he could join the school plan because Cobra is so expensive. At the very least, Obamacare has saved my family from significants costs. And, because he now has a pre-existing condition, it’s the only reason he can buy health insurance and will be able to for the rest of his life.

A reader in Georgia:

My ex and I are splitting soon. I’m leaving my job in a few weeks and moving to another state across the country and will be unemployed for a few months as I switch careers. He’s staying here and working his way through his last couple of semesters of college. He has a pre-existing condition that requires medical oversight and expensive prescriptions. Until I leave my employer in a few weeks, I pay for his insurance through my employer-provided domestic partner coverage. Now that I’m leaving my job and moving to another state, he will have to purchase insurance on his own, something that was impossible before Obamacare due to pre-existing exclusions from the individual health insurance market.

Because we live in a GOP state, thanks to Obamacare, he can buy insurance (yay!) but doesn’t make enough to qualify for subsidies (boo!). Instead of something affordable, he has the option to pay full-cost for ACA medical coverage ($200 to $250/month) in addition to the deductibles for medical visits and prescriptions needed for his medical condition. He doesn’t make enough annually to qualify for subsidies because he is a full-time student and part-time employee. If Georgia had opted into the ACA Medicaid expansion, he would have qualified for that, saving the monthly premium altogether.

There couldn’t be a starker contrast between the two parties on healthcare. The Democrats want to make it available to millions of Americans like him and the Republicans are doing everything in their power to prevent that from happening. As a bonus, they are also fighting against raising the minimum wage, which would be a huge boost for all the students out there who have to support themselves and go to school. More and more, the GOP seems to be working against hard-working Americans and not for them. I don’t understand why more people don’t see this.

Another reader in a red state:

I am a physician working in Indianapolis. Much of my work is at a county hospital system that supports the poor of the city by providing healthcare to any citizen in the county regardless of their income. Obamacare has allowed many of these patients to come off the county system’s rolls.

Indiana sadly has not fully expanded Medicaid because our governor, uber Republican Mike Pence, refuses to do so. Even without expanded Medicaid, many of my patients have been able to sign up and all are incredibly appreciative. One interesting effect is that many of them now have the ability to get a second opinion and different care options because they are no longer tied to the county system. I started to get worried about our system (and myself) when after the first of the year, I had about five patients leave for second opinions but was rewarded by all of them returning to our practice. Obamacare has allowed these patients to both not be tied down to a system strapped for funding and also gain confidence in the care they receive when they note that we are caring for them just as well as they can get elsewhere.

Our system has its limits and we can’t provide some very expensive care, like radiation, but Obamacare allows these patients to find providers that can give this care. This effect will reduce suffering and prolong lives. I have always been a big supporter of this legislation but the benefits I am seeing are remarkable and under reported.

Another in the medical field:

I have a lifelong chronic disease, Crohn’s, for which I take a biologic that costs about $130,000 per year. These meds keep me and many other people healthy, and out of the surgical OR and off emergency room beds. It also saves me from debilitating pain and allows me to be a productive member of society. Before the ACA, I was stuck paying incredibly high premiums (>$1300/mo) through COBRA and then a HIPPA conversion plan.

Unfortunately for me, I live in a state that did not (yet) expand Medicaid, and since I am a no-income student, I do not qualify for subsidies on the exchanges. So instead, I use my school’s health insurance plan, which is better than nothing, but not excellent. With no out-of-pocket-maximum, I end up with about $10,000 of out of pocket costs every year.

While the ACA hasn’t given me cheaper insurance, it has given me immense security knowing that if my circumstances change, my medical care won’t suffer. As you wrote of your own experience, “It gave me a baseline of security that simply didn’t exist before.”

Finally, and perhaps most interestingly, as a medical student, the ACA has changed the landscape for medical providers. I anticipate that it will pump money into the medical establishment’s pockets much like Medicare made physicians rich several generations ago (and continues to do so today). Whether that is a good, bad, or neutral thing, I can’t say. But for those people who now newly have access to a lifesaving service, it is of incalculable value.

I still cannot understand how the advocates of Obamacare have failed to use one of the strongest conservative arguments for the program: the elimination of one of the principal roadblocks that innovative Americans face in starting their own businesses.

My wife is an instructive example. She’s a medical writer who edits journal articles and consults on New Drug Applications for experimental new drugs. She’s been the project lead for the approval of several new drugs that you’ve probably heard of. When she went into business for herself at age 45, you couldn’t have named a better example of the can-do spirit that the GOP claims to support.

But she has high blood pressure and a child with autism. Neither of these conditions has had any significant effect on our healthcare costs, but BOTH of them are considered pre-existing conditions. Without the healthcare coverage I have from my full-time job, she literally could not have obtained coverage at all. This isn’t idle speculation on my part; I considered starting a full-time business of my own a few years ago but found that it was simply impossible to obtain insurance.

Why on earth isn’t there some Democrat somewhere shouting this pro-business message from the rooftops?

Several more readers share their stories:

I just read your piece on the meep meep that is Obamacare and I am surprised that I haven’t heard more about how it is helping small business owners like the two of us. I left my job with benefits several years ago and started my own psychology practice, enabled in part by my wife’s insurance through her job at Duke. She was overworked and underpaid, but they provided us with good health insurance, so she stayed. At the beginning of this year, she was finally able to leave to start her own private practice. Now she is her own boss making more money and we are much happier all around. We chose to continue with her previous policy because it is slightly cheaper but could have easily gone on the marketplace and found a comparable policy. And we will in 18 months when COBRA runs out.

But the real boon had been to my employees (I am fortunate to have two wonderful colleagues who work with me). While the small business policies with only three employees were cost prohibitive, the individual policies are not. So they get good health coverage and an extra little bit in their checks each month that I contribute to cover some of their costs. It costs my company a little extra a month but I’m happy to pay it. They save about $400/month each on top of that. I’m in the process of hiring another well-qualified psychologist. She can afford to work for a small business because she can get affordable health coverage and I can provide a benefit to hire the best qualified candidate.

I can afford the types of employee retention policies that I have implemented because of Obamacare. My employees get good health coverage. And I can keep growing my business attracting the best clinicians from the likes of Duke and UNC. Best of all, our patients can also afford good coverage and will get good care. It’s a win-win all around.

If the Republicans really cared about small business owners, they would be supporting this law. Surely there are some left? I know the answer to that question and it’s unfortunate. Maybe in a couple election cycles the GOP will come wake up – if they’re still around.

Another:

My brother is 62 and the owner of a small garden center that employs about six people. It’s a seasonal (April thru November) business that is subject to the whims of Maine’s weather. Some years he can cover expenses and turn a small profit; other years it’s touch-and-go. As a result, he never felt like he could afford health insurance. Luckily, his health has been good and regular check-ups were paid for out-of-pocket. But a catastrophic injury or illness probably would have spelled bankruptcy, the end of his business, and the loss of those jobs.

ACA made it affordable for him to buy health insurance this spring. Now he is not at risk of losing his business because of injury or illness. A small business, the kind that Republicans supposedly hold so dear, has been made just a little more secure and stable precisely because of Obamacare. Shouldn’t this be something the GOP is 100% behind? Meep meep indeed.

A less straightforward story:

I run a smallbusiness with few dozen employees in California, Michigan and Washington. We cover 100% of employee health insurance premiums. We have always had robust plans with low deductibles. I did not think that we would be affected at all by ACA.

However, in December our insurance brokers called asking if we wanted to renew our group health insurance with the same provider for one more year at the same rate, or risk paying more when our insurance policy expired in June. There was a vague warning that under ACA our insurance rates may go up dramatically. But the catch was we wouldn’t be able to tell what the new rates/plans were until sometime in March. We had to make that decision to renew in December with incomplete information. I wasn’t entirely happy with our current insurance provider and wanted to shop around. I also didn’t really believe the hype that our rates were going to be rising, so I decided I’d rather shop around new plans when they became available.

It turns out the ACA did shake up the market for small group insurance. Anthem, our current provider, eliminated their low deductible plans for small businesses. The closest similar plan through them called for a 300% increase in deductibles. This came at an 8% savings to our company over the previous year. However, I didn’t think this savings at the expense the employees would do much for morale.

After viewing a large number of options, we decided to go with Blue Shield, which has a zero deductible plan with better coverage than our previous plan. The cost of the new plan is about 9% more than we were paying in the previous year. This increase was acceptable to me and is less than our insurance costs had increased in previous years for lower coverage.

I am happy with paying a little bit more for our new insurance. Our employees are happy to be paying a bit less. It is true, as the Republicans warned, that we didn’t have the opportunity to keep our previous insurance. But being forced to look at different vendors allowed us to buy something that was of better value. Overall, I think the ACA has been a net positive for this smallbusiness.

I was going to get a new car, but the increase in my premiums sapped up the income I’d set aside for the additional expense. So I guess I’m stuck with my 12 year old truck. Oh, should also mention that my deductibles nearly tripled and my coverage sucks in comparison.

Another reader:

While I recognize the large-scale benefits of the ACA, we found its implementation absolutely devastating to our small business. Our company is a medical device developer/manufacturer with about 12 employees. Because we employ mostly high-pay, high-skill engineers and scientists, almost none of our employees qualified for any sort of subsidy. Most of our employees are married and have kids, so they needed the most expensive policy, the dreaded “Self + Family” option.

Because we are a small-business, we did not have the H.R. resources to shop for private insurance and had to contract a third party to do so for us. And because we are a small company, we had virtually zero bargaining leverage with insurers. Larger companies in our area ended up with much better group policy offers from the same insurer as us. In general, our policies went up about $300/month per employee, and our deductible increased from $2,500 to $3,850.

But what is the absolute worst is that insane 2.3% medical device tax enacted to “pay for” the ACA. It taxes gross revenue, not net profit, so even if our company were to have a down year where we actually lost money, we STILL have to pay that tax on our total proceeds from sales (no matter what NYT columnists claim, most medical device companies aren’t enjoying massive profits via monopolistic evil).

This is completely absurd. I am a wildly left-leaning proud socialist, and I recognize the utility of taxes to pay for things, but the idea that gross income is taxed instead of net profit is a giant FUCK YOU to medical device companies. And worse yet: the pharmaceutical industry doesn’t have the same tax! If net profit were taxed, let’s say, then medical device companies could pour their profits into R&D prior to being taxed, which would foster innovation, bolster high-pay scientist/engineering jobs, and generally help the sick in this and other countries.

Long story short, someone obviously had to get the short end of the stick in ACA, and it is patently clear that it is the small, high-tech businesses who had no lobby.

Another:

I have been a supporter of the President and the ACA since the beginning. I certainly understand the political compromises that had to go into the development of the law and it’s far from perfect, but I was certain it would help a lot of people and help bend the cost curve of medical expenses.

However, my personal experience was somewhat shocking. I pay the full price for my family health insurance plan and my premium costs went up by 21% over the previous year to just under $1,650/month. I still have a $1,500/ $3,000 deductible and my co-pays on both doctor’s visits and medication went up by a few dollars as well.

Being in Massachusetts, my plan didn’t have to change very much to comply with the ACA. Guaranteed insurability was already state law, and a few small additions were added to the plan; doubling of rehab visit days in a calendar year, mental health visit co-pays equalized with other doctor co-pays etc. They also added pediatric dental as a requirement, but looking at plans that didn’t have that provision (if you had external dental coverage you could drop it) only lowered the premiums by about $30 a month.

I’m willing to put my money where my mouth is and pay extra if it’s helping implement a law that I believe in, and I make enough money that I can begrudgingly afford it. But this experience tells me that the upset self-employed and small business owners on Fox News talking about the unaffordable costs of this law are not completely full of it.

I was really taken aback by how much my premiums increased – much more in both percentage and dollar terms than in any other year, yet health care cost inflation was supposed to have leveled off? Trust me, I shopped around so it wasn’t just my provider; all plans similar to mine cost within $100 a month of this one – and it’s still considered a bronze plan (HMO not PPO). I have yet to see any justification for this increase and I hold out hope that our Mass. Based insurers are just overestimating costs and I’ll get a nice fat check next February when Harvard Pilgrim pays less than 85% of their income in benefits.

Like I said, I’m willing to pay the extra money – but single payer still sounds pretty good to me.

You wrote, “When you are a long-term HIV survivor, that kind of health security and independence is, well, priceless.” Take out “long-term HIV” and replace it with “person with diabetes” or “person with a seizure disorder” or “person with a heart condition” and all of us feel that same security and independence and relief that you describe. I’ve had well-controlled diabetes for almost 30 years, which includes my entire working life. And for my entire life, I’ve known that I had to get and keep a job that offered a group insurance plan (or be married to someone who had that) in order to take care of myself and be financially stable (i.e., in the middle-class).

So that’s what I’ve done; I worked when my ex-husband was in graduate school (his school coverage didn’t cover pre-existing conditions); I put off having children until he had a job with group insurance; I worked at in the most toxic law firm environment I can imagine for 6 1/2 years because I was divorced and had to provide my own coverage; I finally left when I was hired by the federal government (admittedly, a lot of benefits came with that move, not just good health coverage).

But in the last few months, another sense of freedom has crept up on me and I realize that NEVER AGAIN will I feel trapped by my job as I have for my entire working life.

If I decide to leave the law, I can. If I want to piece together several part-time jobs that that allow me to use my other skills and would provide me with the minimum income, I can do it. It’s all up to me. I have no more excuses. It almost feels like personal responsibility and freedom and adult behavior all wrapped up together. But that doesn’t make sense, because then the Republicans would be all for it, right? I am so thrilled that Obamacare exists and I use the name proudly whenever I can. Another meep-meep for the ages!

[The ACA’s] assurance of a stable insurance market that does not screen out someone with a pre-existing condition made me far more comfortable starting my own business. It gave me a baseline of security that simply didn’t exist before. It helped make entrepreneurialism possible.

Amen. I live in Silicon Valley. As dynamic as this place is, I can’t tell you how many former colleagues have stayed in jobs just for the benefits. I really don’t understand why employers don’t want to get out of the healthcare business. It’s not a core competency and it’s nothing but a headache. This American Life had a story about how medical benefits became a way to lure workers during the WWI’s government-mandated frozen wages.

I’m currently in a struggling startup with no benefits. I have them through a partner, so I’m one of the lucky ones. I wonder how much innovation is being locked up by employer-based healthcare.

Another has part-time job freedom:

I am a 27-year-old freelance photographer and writer who works in the skateboard industry. I’m also a semi-professional downhill skater. It’s pretty much my dream job, and I wouldn’t have been able to chase it down without Obamacare. The ability to stay on my parents’ insurance until I was 26 gave me the freedom to move across the country and participate in a risky physical activity without fear of financial ruin. Later, when I aged out of my parents’ insurance, the lower premiums made it possible to afford insurance, without which I could not skate. (Thankfully, my sponsors pay for it.)

If the ACA hadn’t passed, I would be working a boring, stable office job instead of traveling the world pursuing my creative passion. Obama disappointed me on civil liberties and accountability for torture, but the Affordable Care Act has made a real and important difference in my life.

And this reader has freedom from jobs altogether:

I got health insurance through Covered CA. I’m 64 and Obamacare allowed me to retire a year earlier. Before Obamacare I would have been uninsurable and have to keep working to get employer-based coverage. I worked as an RN for 38 years and was wearing out fast. It’s the best thing that could have happened.

My husband and I are both self-employed and work from home, and for the first time, our entire family has health insurance – thanks to Obamacare. My husband was uninsured for years, because he just couldn’t get health insurance that wasn’t exorbitant. In 2012, he tried to get health insurance from three different health insurance companies and got turned down from each one for minor health issues. The reason for his last rejection was – I kid you not – “impending fatherhood.” When a health insurance company declared that my pregnancy (which was covered under my insurance) somehow became a pre-existing condition for him, we gave up on the whole Kafka-esque scenario and just waited for 2014.

But I mostly want to highlight another Obamacare benefit that hasn’t been mentioned much: mental health coverage. I have PTSD, which my pre-Obamacare policy didn’t cover. As a result, I could get 10 group or individual therapy sessions per calendar year, and I could see a shrink once every two months for ten minutes for medication management, and that was it. I could never switch policies because no one else would cover me. (Put PTSD on a health insurance application and they couldn’t write the denial letter fast enough.) I spent $18,000 out of pocket to treat my PTSD (and four years after completing therapy, I’m STILL paying off the resulting credit card debt.) EMDR was worth every damn penny, because while I still have some remaining symptoms, I can actually sleep through the night, I don’t have to manage multiple flashbacks a day, and I’m not crawling out of my skin with anxiety twice a day. I’m grateful that my therapist offered a no-interest payment plan and that I had the resource of a high credit limit, but not having health coverage for my PTSD treatment was a huge financial hit at a time when I was already struggling to get by.

Like a lot of people with a mental illness, I don’t broadcast my PTSD diagnosis – mostly because I don’t necessarily want to discuss my abusive childhood in public. But access to mental health treatment is a big deal for a lot of people like me, and I’m grateful that I have options now that I didn’t have before.

Another also touches on mental illness:

I love this thread, and I thought I’d chime in because the policy has meant a lot to me and my family. My mom is very well employed and well insured. However, prior to Obamacare her coverage only covered her 7 children if they were under 18 or in school full time and under 25. This was without a doubt a luxury plan in comparison to the vast majority of Americans.

Cue disaster 1. My brother had to drop out of college after a suicide attempt and diagnosis of bipolar disorder. He was in inpatient care for weeks, and then seeing multiple doctors to find the right treatment plan to manage the illness. For years.

Now, again, my family was in a relatively secure position prior to this. But the fact that the Obamacare clause for children 26 and under came into effect just six months before this disaster means that my mother didn’t have to make a choice between bankruptcy or leaving one of her children to homelessness or death. Because that’s what the options were pre-Obamacare. And I’d like to point out that no matter how well you raise your kids, no matter how much money you have or how hard you work, you can’t prevent bipolar disorder. You don’t get a choice as an individual to have a mental illness (or cancer, or asthma, or allergies …). How can anyone want to go back to a world where your financial security depends on the luck of the genetic draw?

Once that had (mostly) settled down, we hit disaster 2. My other brother graduated from college, unemployed, and came home to work. He was working three jobs to make ends meet when he got in a motorcycle crash that left him inches from death. He was in the hospital for the better part of a day before they were even able to identify my mother and call her. He woke up two days later and but for the grace of god was not just alive but didn’t lose any brain damage. He spent weeks in inpatient rehab, several more in outpatient rehab, and a year later had the final surgery to fix his hip.

To be clear, my brother was working three jobs and none of them offered insurance. He is the epitome of a the “hard working American.” And once again, if it weren’t for Obamacare, he would have spent decades of his life trying to come back from financial ruin. Or my family would have gone bankrupt.

If there’s anything I learned from my family’s story, it’s the crushing economic impact of not having health insurance. Without that one clause, my family would have gone from gone from solidly upper middle class to near-poverty in a single generation. We would have gone from drivers of the economy – spending money on restaurants, vacations, college, homes – to the paycheck to paycheck existence that too many Americans endure. I am aware of just how lucky we are, and I wish other people who think Obamacare is only the rich subsidizing the lazy poor would realize just how much security and wellbeing Obamacare has brought all Americans.

I saw this thread and how timely it is! Last night I went to the lady doctor (that’s my euphemism for gynecologist) for the first time in over a year, just for my annual check up.

Cost of annual check up: $0
Cost of three-month supply of birth control: $0
The feeling of getting free birth control for the first time in my life (that wasn’t a bunch of condoms): PRICELESS.

I’m still on cloud nine from it 24 hours later. It’s the little things, ya know? Those three packs, in the past, have cost me anywhere from $60 to $100. On average, $20/pack/month, for a yearly savings of at least $240! You don’t have to be ill to benefit form the ACA, healthy people are helped too. Obamacare FTW!

Another:

Obamacare changed absolutely nothing about my (employer-based) insurance coverage except for one thing: free birth control. The previous copay was in no way burdensome, but it regularly makes me appreciate the impact on the high school students I teach and how much I appreciate the law making it easier for them to graduate sans-baby. However, the numerical impact of the law doesn’t take into account the relief I get from knowing that I don’t have to worry about how getting tests done to see if a lump is benign or cancerous (benign, thankfully) will look to an insurance company if I ever do strike out on my own. Or my relief that a close friend with multiple pre-existing conditions doesn’t have to worry about coverage. Changes in healthcare affect far more than the people who show up in the statistics.

Another:

The reader who told of his PTSD and need for mental health coverage, which he is finally able to receive thanks to Obamacare, reminded me of my biggest complaint about the program. It ought to have included dental care instead of elective contraception coverage. Some years ago, I experienced significant dental issues but possessed only medical insurance. Had I allowed my condition to deteriorate such that I could no longer eat, perhaps then medical coverage would kick-in, at great expense and after great suffering.

It baffles me still that medical, dental, and mental health are handled as separate segments in the overall health care system. Need I point out the obvious that each individual is a whole person with a single body?

Access to medical, dental, and mental health care are true human needs. Obamacare should have focused on meeting all those needs, including the mental and dental coverage that too many employers had failed to make available, instead of opting to cover the pill. Except for it palliative uses, the pill is not a form of health care.

Access to medical, dental, and mental care are true human needs. Obamacare should have focused on meeting all those needs, including the mental and dental coverage that too many employers had failed to make available, instead of opting to cover the pill. Except for its palliative uses, the pill is not a form of healthcare.

First, I would ask, why is this an either/or situation? Why pit this one benefit against other benefits? Physical, mental, dental, and reproductive health are all essential human needs. In fact, I would also add vision coverage, as those of us with very bad vision know we cannot operate in the world without the help of optometrists. Shouldn’t we be advocating for a more holistic approach to healthcare and not elevating one type of care over another?

Secondly, I must strongly disagree with the claim that “The pill is not a form of health care.” This is simply erroneous. I know a number of women who take birth control for reasons unrelated to preventing pregnancy. Most of them use it to treat very painful periods or endometriosis. I know one person who uses it as estrogen therapy to treat Turner Syndrome, a genetic condition resulting from a missing X chromosome. In fact, only 42 percent of women use the pill only for contraceptive purposes, according to a 2011 study by the Guttmacher Institute. Maybe your reader does not consider those uses to be a form of healthcare, but most doctors would.

Finally, even preventing pregnancy is healthcare. Pregnancy is not an illness, but it is a condition that affects a woman’s health. Pregnancy can put some women at great risk, because they have other health problems. For the rest of us who do not currently want to be pregnant, it is a relatively safe and easy method for us to prevent pregnancy – a method that does not require us to rely on a partner’s willingness to wear a condom. Of course, in theory we should all be having sex with partners who are willing to participate in safe sex, but we know that relationship are very imperfect and sometimes dysfunctional or even abusive. The pill is a way for a woman to have autonomous control over their reproductive health. It is a way to prevent a change in one’s health.

Another speaks from personal experience:

Did you notice that health-insurance companies made not a peep about covering birth control? And that they very quickly figured out a way to cover employees of religious hospitals, universities, and other religious employers with separate birth-control policies that would allow the institutions to save face? It is long-run cost savings for them.

I am prescribed “birth control,” which costs $100 a month and does prevent pregnancy – which, as I am 48 years old, is a good thing for me and for all my fellow policyholders. A pregnancy at this point in my life would surely be a very expensive prospect. But more than that, my “birth control” prescription ended the debilitating deluge of menstrual blood that began in my mid-40s, likely caused by the same condition that required my mother to have a hysterectomy at age 48. So my insurance company and fellow policyholders are shelling out $1,200 a year to prevent pregnancy and to prevent an expensive hysterectomy and the subsequent recovery time, which would cost many thousands more.

I expect to be taking this preventive “hysterectomy control” prescription into my early 50s, when my body should end the deluge on its own, thus avoiding an expensive surgical procedure for my insurance company and fellow policyholders, as well as keeping me on the job rather than suffering through the monthly challenge or the surgery that would have been required to stop it. Those savings can eventually be used to pay for expanded coverage of things like dental care – or at least they should.

Another ties the personal issue to a political one:

If Hobby Lobby prevails, their female employees with menorrhagia would have no choices for treatment except surgery – which leaves you unable to later get pregnant and comes with risks not present with the other medical options. “Birth control” is not just birth control. Would a male legislator who had lived one week out of every month bleeding uncontrollably still think it reasonable to deny women access to this treatment?

I have a “Dish Double” for you! First, thanks for your recent series on Truvada. Somehow I hadn’t been aware of the Truvada PrEP. I’m a 47-year-old gay man who is HIV negative but I had recently found myself engaging in riskier behavior. After all these years, condom-fatigue had set in and with AIDS becoming a manageable disease, the fear that once kept me from indulging in barrier-free sex has passed.

Don’t get me wrong; I was and am not seeking to become positive. I just was finding myself in a position where the idea of using condoms forever was no longer an option for me. In other words, I’m a perfect candidate for a Truvada PrEP regimen.

Which brings me to the view from my Obamacare. I’m one of the people who was not able to keep my old insurance policy and is now paying more than double each month for my policy. I should mention a few things about my old policy. When I first purchased it back in 2002, I was 35 and had never had any major health issues, so it seemed like a great policy. The premiums were low. Sure, it had a $3500 deductible and no prescription coverage, but so what. I was young and healthy.

Until I wasn’t.

Just before I turned 40, I experienced some medical issues that resulted in hospitalization and ongoing care. Everything is fine now, but for about six months I was seeing doctors once a week. While my insurance did cover most of it, I still faced some large bills due to the deductible and prescription costs. The experience revealed the severe limitations of the policy. It was basically a catastrophic coverage plan. Of course now that I was the proud new owner of a “pre-existing condition”, it was the plan I was stuck with up until this year.

The view from my Obamacare is that my new policy has a premium that is a bit more than twice what my old insurance cost. My new policy also has prescription coverage and a very low deductible. I added things up and with my new policy, I am expecting to save thousands of dollars each year. My Obamacare may cost me more in premiums but it will offer significant savings elsewhere.

Which brings me to my “Dish Double”. After your articles about Truvada, I made an appointment with my doctor to see about starting a PrEP regimen. My doctor was immediately open to it. I had the required blood tests and my doctor called in the prescription. When I went to pick it up, I was expecting the worst. I wasn’t sure if my new Obamacre would cover it but If I had to pay the full $1,700 monthly cost I would. It was just too important to me. When I got to the counter, I discovered that my monthly cost for Truvada is …

$15

Right now the view from my Obamacare is fantastic, and as of last week I’m on the pill.

Another is paying even less:

I’m just writing to say that thanks to the recent thread on the Dish, I just took my first dose of Truvada for PrEP. There are a lot of reasons I’d been skeptical of it in the past, and my HIV risk these days is not nearly what it was when I was, say, 23. But I’m still single and gay and sexually active. I use condoms, but on those occasions where it doesn’t happen for whatever reason, I can quit torturing myself for the next two weeks worrying. I do not expect it to change my behavior (although time will tell), but it will liberate me from these cycles of excruciating worry.

So thank you. Bonus: It is costing me precisely $0.

Update from a reader:

Thank you for your post on gay men’s health. I feel compelled to say that I definitely relate to the 47-year-old man who wrote to you. As a 47-year-old man myself, I am also considering going on Truvada. I think we need to have an adult conversation in the gay community about widespread use of this drug as a HIV-prevention strategy, rather than just relying on someone just using the same, tired 30-year-old safer sex campaign, and wagging his finger at younger gay men saying “use a condom every time”. Even if I go on Truvada, I still plan to use condoms for there are other STIs out there that I don’t want any more than HIV.

That said, “condom fatigue” is a REAL issue in HIV prevention campaigns in the gay community. When many of us were working on safe sex campaigns in the 1980s, most of us never imagined we’d STILL be telling people to simply “use a condom” three decades later. I know gay men of my age who had been practicing “safer sex” for twenty to thirty years and eventually just got sloppy with safer sex, a handful of whom then seroconverted even after two straight decades of having safe sex. Truvada might have been of help to them.

Also, with crystal meth use being a tragic problem in the gay community, if Truvada can help spread the stop of HIV in these cases, where the crystal overwhelms any safe sex message, and most people I meet nowadays who have seroconverted admitted to drug use as a contributing factor, how can we not spread this drug as widely as possible?

For those who say that Truvada will only encourage unsafe sex, I laugh at them as much as those who preach abstinence-only birth control; both are people who have no connection with real life or the real world.

Another dissents:

So we’ve heard over and over again in the press coverage concerning Truvada PreP that it doesn’t lead to riskier behavior. This evidence comes from a single study (though it was conducted on a variety of gay male populations around the world). Your two emailers in the Obamacare post, and my own experience so far in the gay community, give the lie to this claim (at least for gay men in the US). I’m not saying I disagree with PreP – but it is simply dangerous to be anything less than honest about what PreP means to many gay men like your reader with “condom fatigue” who will now engage in riskier behavior because of the protection of Truvada. There is danger down this road …

For three days straight, a crew of two men has performed significant physical labor around our residence – drilling through brick and mortar, removing debris, and so much more. The toll on these guys’ bodies is beyond comprehension to a sedentary writer-type, who obsessively exercises to keep limber and burn calories and maintain a semblance of muscle tone.

For three days, one of the men complained regularly about his back pain. (Which certainly wouldn’t have been helped by carrying away our cast iron wood stove, lifting it onto the truck, off-loading it at the shop.) With a groan, he sat down to write up the final invoice. By now fully aware of his problem, I murmured sympathetically. He replied, “I had an MRI done a couple of years ago. It’s a disk. I need surgery.” I cranked up the sympathy. “I can’t afford it,” he continued matter-of-factly, “on my income. Not until I get my health insurance.”

I very nearly said something like, “Isn’t it great that it’s actually possible through the Affordable Care Act?” and was tempted to explain that next enrollment period comes up later this year. I’m fairly well informed on the process; my husband’s workplace arranged for him to become a certified ACA advisor. All winter long he came home from the office with heart-warming news of how real, uninsured people were at least accessing what was previously unobtainable.

But, stifled solely by the crewman’s demographic characteristics, I said not a word. I could just tell this was not a fellow who would look favorably on Obamacare. And I didn’t want to introduce controversy or politics into what had been a pleasant temporary relationship.

Shortly before leaving, he spotted the framed photograph of me standing with President Obama, taken when he was a little-known candidate roaming through my First-in-the-Nation primary state. And his recognition prompted a rude comment that made me wish he’d had been as reticent about the president as I had been about the ACA.

When he and his cohort departed, I started to cry. Our entire exchange represented everything most depressing about perceptions of Obama and the intent of the law he – and the Congress, even if only a portion of it – brought into being. For the good of people like the man who needs back surgery to continue in his job, but can’t afford it. And who, until recently, wouldn’t have had a hope of getting insured.

Most of the time I do Know Hope. I’m hard-wired that way. But today there’s a terrible disconnect in my optimism.

Update from a reader:

Allow me to bring your reader’s experience with a temporary worker in her home a bit closer to home. As a small business owner with a long-standing (since age 17) preexisting condition who has had to buy my own insurance, the ACA has been a godsend. We went from our premium costing nearly $2,000 a month for our family of four to $1,100/month with much better coverage. And now I’m about to enter a job transition where I might not have an income for a few months. The ACA has made that much easier. A major health crisis would be horrible obviously, but one happening if I didn’t have insurance, it’d be financially devastating. I now can know we are covered and can afford to be even in job transitions.

But my sister doesn’t see this. She complains constantly about Obama and the ACA – complaints that more often than not have no basis in fact. She works several part-time jobs and her income, just above minimum wage, is volatile. She refuses to even look for an insurance plan on our state’s very good exchange. I am fairly certain she would find one, with subsidies, that would cost her under $100/month for silver plan coverage, barely $30 for bronze, coverage that could make her life healthier and more financially secure. She has several pre-existing conditions herself and current health issues she really should take care of now.

And it breaks my heart she refuses to do so out of some misplaced anger based on “Fox News” lies. The Fox News Republicans have done a great disservice to this nation in so many ways.

It’s nice to see some of the stories you post about how much the ACA has helped people. The stories where people mourn for those who refuse it and need it are sad. Allow me to present you with a third type, the people who aren’t eligible due to system bugs.

Yep. Jack and shit for my family. I tried to sign up, since my wife and kids’ coverage ended in May and the ACA won’t cover them. We aren’t rich. We’re lower-middle class, according to the federal poverty line, but out of red state Medicaid income levels. I tried the site – nothing but errors. I spent an hour or more on the phone and neither the persons I spoke to or their supervisors understand why they can’t process it for us. I could call my senator or congressman, but I doubt Lindsey Graham or Trey “Benghazi” Gowdy will investigate.

I’m disabled and currently get Medicare. Prior to May, my wife, two small kids and I all received Medicaid. It was my secondary provider and the only coverage for my wife and kids. My wife had been in school full time and started working two jobs at the end of last year – one ultra low-paying factory job and another seasonal government position. A few months later she was offered a permanent position at the government agency. Our income went from close to the poverty line to significantly higher than that. Not wealthy or even upper middle class, but not subsistence level either. Our income increased and I didn’t want to accept benefits fraudulently, so I called up Medicaid and told them about the income change (not easy to do since the state has minimized the number of social workers) and they set coverage to end that month.

Next I use the ACA website calculators and make sure we are eligible. I try to process an application and there are tons of errors. This is on the federal site. My state (South Carolina) didn’t do anything regarding ACA exchanges. I then call up the ACA support line. He walks the app through the same way I just did and it says my family isn’t eligible. Nothing. He puts me on hold for long periods to consult supervisors. Nothing. My family’s coverage ended, we meet all criteria for coverage, we are all US citizens – born and raised here. Nothing.

No explanation. No assistance. Nothing. They couldn’t figure out why. We are eligible to get coverage outside of the yearly switch period due to loss of coverage according to the rules and staff. So we meet the requirements but the computer hates us.

Anyway, glad it’s working for someone I guess. Must be nice.

Update from a reader:

I’m confused about one notable detail – the writer mentions a wife who recently started a permanent government position. If this is a Federal position, the writer and the kids would almost certainly be eligible under the FEHB (Federal Employees Health Benefit program) – the full family coverage is more somewhat more expensive than individual plan, but very likely a pretty reasonable deal out of the wife’s paycheck.

If this were a state position – or certain (fairly common) local government positions – I think the family would be eligible for the different options available under the South Carolina’s Public Employee Benefit Authority coverage. It looks to me that the deals here are a bit more expensive than the options under the FEHB options, but that’s a pretty quick peek.

Only wrinkle I’d be able to imagine seems a little bit arcane/improbable to assume: if the wife were divorced and there were a former spouse that had a divorce decree requiring the wife to provide coverage, that might be an issue, since SCPEBA only allows one spouse to be covered, and the divorce decree’s mandate might trump the current spouse’s coverage.

In any case, I think that the wife checking with her benefits administrator about expanding coverage from individual coverage to full family coverage would be a more economical strategy than trying to insure the spouse or spouse and children under a separate ACA plan. Hopefully, this sort of request would be pretty common and straightforward for the wife’s benefits admin.

The original reader follows up:

Those options for federal workers don’t apply because it’s a union job and the contract provides for some weirdness. She can join the union any time but can’t get healthcare until she’s been working her contract for a year. Even then she wouldn’t be eligible for most of the other normal federal benefit programs like life insurance until she is “converted” to a career position.

Welcome to the new United States Postal Service. Career-track mail clerks and carriers begin in a position that pays similar to career posts or even more, while having virtually no other benefits except annual leave (paid time off). The USPS will pay for a large portion of our insurance premiums come next year, but until then we are out in the cold.

The family is in great health with the exception of me (here’s a plug for CIDP – Chronic Inflammatory Demyelinating Polyneuropathy – similar to MS). We were broke with insurance and now we’re less broke with the possibility of being broke again if a medical situation arrises.

It’s disappointing, but hey, my 2nd grader was doing algebra two years ago and his little sister is on the same path. They’ll be in college by 12 or 13. I can still type, knock on wood. Sometimes you win, sometimes you lose. I count myself lucky if anything this nation manages to do is actually aimed at helping me. If it doesn’t hit the mark, at least Obama tried.